Revenge Flexes and Rotted Morale: Tales from the Southern Communications Circus

Destroying EMS Dispatch.

Dispatch used to be too simple. "What's the address... What's the phone number... What's wrong?" That was the complete interrogation narrative when I started at Calgary 911 Fire/EMS Dispatch. I don't remember ever running out of Ambulances, it just didn't happen.

On January 1, 1990 EMS Dispatch separated from the Calgary Fire Department over the use of the new 'Emergency Medical Dispatch' Protocols. Paramedics were now able to ask questions about the patient complaint and give instructions to Save Lives and Prevent Further Harm. Dispatch also asked questions that were critical for establishing if the scene was safe for Paramedics to enter.

The Dispatchers who weren't part of the Paramedic Union switched over and we all worked for Calgary EMS. Through the '90's and up to 2009 every Municipality had their own Ambulance Service. We developed mutual aid agreements, had our own Dispatch systems while developing and sharing staff development and training resources.

In the early part of 2002, Calgary EMS Dispatch was targeted by the City of Calgary to move away from EMS HQ to the new Municipal Dispatch Centre. In the midst of my own ACP education I met Susan Garnett, who was touring EMS as part of her role as head of the new Communications Centre. Taking an instant dislike to her I transferred to a full-time street Paramedic position. Turns out very few people liked her and she was told to clear out her office and leave the building a few months later. Imagine that! If only the same could be said of todays “leadership”.

In 2009 the Alberta Government took over responsibility for EMS from the Municipalities. That's too simple a statement, there were a lot of reasons given that we won't go into here. Suffice to say there was a lot of resistance, from Paramedic Unions and some Municipalities. A lot of good Rural Systems and Volunteers were discarded, deemed 'not useful' to the new provincial overlords. While some goals of 'leveling up' smaller Rural Communities with Advanced Care Paramedics were welcomed, the highly advanced Urban System in Calgary declined rapidly. Without going into too much detail, EMS became fully subservient to the Hospitals, costs skyrocketed and everything that made Calgary EMS a top tier North American EMS began to slip away. While there's no real proof, I remain convinced that removing Paramedics from their own Independent Union into a Health Care Bargaining Unit and keeping EMS Dispatch under the thumb of Calgary 911 was done as part of a financial deal between the Province and the Urban Municipalities.

For a while, there was hope and many of us did what we could under the new system. Sadly, the writing was on the wall and the failures came swiftly and repeatedly. We've documented much of it throughout wheresmyambulance.com and we encourage you to read our other posts here. Much of the work I personally did is online at slideshare.net/DonSharpe for anyone who's interested to view. It includes articles, projects, letters to leadership and even copies of discipline that in hindsight are clear signs of the dysfunction we were facing.

Please find a second opinion for information on how the Alberta Provincial EMS Dispatch System works. This article has been contributed to by many past and current Dispatch Staff. To be very clear, we believe strongly that EMS must have total control of their own Dispatch. Allowing any other agency, be they Fire, Hospitals or Municipalities to make decisions with any other priority considered will destroy your entire EMS. Having said that, those in charge of EMS also must be transparent and accountable for how it operates. Regarding the current Alberta EHS organization, we have spoken consistently and loudly; every member of the Senior Leadership Team must be fired and no Nurse or AHS bureaucrat can ever be allowed to compromise EMS ever again. 

We are going to focus in this article on the SCC, which while absorbing vast amounts of money seems to be failing utterly. I can only assume from the information we receive that the North and Central Dispatch Centres are at least as bad. Staff tell us the organization declines faster every day, in every way. Street Paramedics say one way they measure the decline is by the number of hilarious spelling mistakes they see on their CAD updates. Here is the exploits given to us by someone within the Southern Communications centre.

The Training Disaster 

Training of new call takers used to take a reasonable amount of time. Call takers were expected to be accurate, consistent, and professional - if they were lacking, there were appropriate consequences and calls would be reviewed and coaching applied via DM or team leads. ECOs were not signed off unless they were actually ready to do the job well and if they didn't meet the standard within a reasonable amount of coaching then they were given the boot. They were expected to follow protocol yes, but there was a level of critical thinking promoted as well. If anyone got a bad QA, they were encouraged to make your case as to why you did something then the DMs would potentially fight to get it overturned. Essentially, they had reasonable wiggle room to use their brains knowing that if it came into question, they would be responsible to explain our thought process. 

Now they want ECOs who don't think and just do the bare minimum and don't make a fuss. Management will push through the most incompetent trainees and go as far to threaten the preceptors to sign them off even if they raise concerns. 

Becoming a Dispatcher was something to be earned. It was common for new ECOs to be on strictly call taking for 9 months to a year before they started training on dispatch. Candidates spent months mastering maps, coverage, and rural logistics before ever sitting down to learn at a Dispatch desk. Now? New hires with zero foundation are tossed into dispatch like contestants on 'So You Think You Can Dispatch'. ECOs had to prove they had the foundations - addressing, ability to pay attention and recognize minute details and an ability to work at a brisk (but accurate) pace. Now it's common to see ECOs signed off for barely a month or two before being pushed over to dispatch training. No experience, no foundation, no idea how it all ties together.

Often lately the first dispatch desks they're starting people on are SSM and IFT. Extremely problematic, especially on SSM. If someone doesn't understand appropriate coverage and if they do not have the experience and connection to medics from dispatching rural and metro, they cannot have an appropriate understanding to do SSM. Period. IFT as well, if someone doesn't understand the coverage and appropriate use of resources they cannot dispatch IFT in a reasonable way. Period. But they do.

The EMD Cult 

I used EMS for years, taught it to thousands of new Dispatchers from 1990 through 2002. After 35 years I'll agree that EMD has its uses, but like any system what matters is how it's used. This dispatcher agrees, but has their own take on the current situation within SCC, and the greater dispatch system in Alberta. 

As far as EMD goes there is value to having a standardized set of questions to ask as it keeps things consistent from call taker to call taker and helps direct the calls into appropriate channels. Where it goes wrong is when it's blindly relied on and ECOs are punished for deviation without truly understanding the protocols fully. For instance, on the stroke card there is an axiom that outlines the call taker should consider situational factors, say when it's a 20 year old who's been drinking since 4 pm and is now slurring their words at 1am - the protocol actually allows for critical thinking here because it's more likely that this person is just trashed and not actually stroking out. 

As a Citizen as well as an employee with a Private Paramedical Service, I've had to call 911 many times. Others I've talked to have been frustrated and disappointed by the rote, monotone engagement with EMS Call takers. 

The ECOs are evaluating not to provide the best response but to avoid the punishment of a bad QA. It all comes down to how the program is used, C911 uses EFD for evaluating CFD calls on the fire side (C911 has two different sections of ECOs - you're either fire/PSAP or police) and is Academy accredited just like EMS but they're not seeing the same issues. C911 also uses EPD for CPS calls on the police side but they're not accredited as they simply use the program to gather information consistently and then it is filtered into their own coding and priority system. Bottom line, a better understanding of the protocols would improve things a lot but also a better use of the information would be a massive benefit too.

The Joy Vacuum of False Leadership 

SCC nailed it. Their new director, a nurse, with zero EMS background but a master’s in “Health Care Management”, beat out actual EMS candidates. They quickly turned dispatch into a psychological experiment in despair. Now they are leaving for CCC, spreading her managerial toxic waste north. Congrats, Edmonton.

The culture at SCC was questionable before but this director really made it their goal to remove every bit of joy in the place. I've never seen someone trash morale as quickly as they have - not even big things, a combination of many small things that all added up. Combine this with a complete lack of regard for concerns raised about incorrect information in the Stampede dispatch document (Cowboys tent was still listed as at its old location, no info on Badlands to name a couple issues) or Chasing Summer or really any big summer event there was a lengthy lead time on.

Deployment managers, or lack thereof, were largely absent all summer. The centre was down to two in centre DMs with one daytime DM that didn't work with a team and largely handled casuals and admin. In addition, the two DMs changed their working hours to end at 2am so they could "handle admin tasks during business hours" leaving the centre with no in-house DM from around 2am until 530am, only leads and maybe a DM at CCC or NCC that could be called. Most of the summer DMs were all on vacation at the same time leaving the centre with no one weeks at a time, dispersing their duties among team leads. God forbid more than 2 ECOs be off at the same time but DMs can all be off together. The DMs are also the root of the "all medics are lazy trash" mindset in the centre, they've completely forgotten where they started their careers. Especially one who will actually clear medics from calls when they have deemed they've been documenting or eating or taking a bathroom break too long. It's the root cause of dysfunction and made every shift a disaster.

As for leads, there are maybe two good ones. The rest have insane egos and nary a leadership bone in their bodies, the only reason they're leads is to avoid doing actual work and throw their weight around. Most use punishment techniques of keeping the good dispatchers away from the metro desk or putting them on long stints of SSM or IFT. Meanwhile the medic-hating dispatchers push crews around on metro dispatch. Creating disorder that targets Paramedics for discipline so they can look good to the senior managers, further toxifying the workplace.

Obey The Computer: Good Dispatchers work hard to keep flexes fair and keep rural crews home. Rural crews cannot be the scapegoats for metro staffing problems or hospitals holding crews hostage in the ER hallway with patients the hospital staff refuse to accept. The garbage dispatchers that do SSM fall into a couple of categories - the ones who use OPTIMA inappropriately and send revenge flexes, and the ones who don't actually check the flexes the program recommends (calculated based on statistics and the SSM policies) and just apply all. The first kind are trash at their core with deep rooted issues where they latch on to anything they feel they have control over, you'll find them running to Sierra 6 constantly about crews not following asinine flexes and even take it upon themselves to CAD message crews passive aggressively with things like "Obey your flex" (Paramedics should take screen shots and file MSNs for harassment/bullying) or even calling the crew phones - there is one VERY problematic individual who primarily does this and she has been there for the better part of 10 years now. Also since Priddis changed to being unable to be flexed into the city, they now get 'revenge flexed' to Cochrane so Cochrane gets flexed into the city. This completely defies the logic as to why Priddis was deemed non-recommendable for city flexes. Ridiculous and dangerous especially with winter coming. The latter, well they're just lazy and management again doesn't care to do anything about it and the crews suffer. 

LOGIS as a program has its benefits, it's very easy to use to organize and plan transfers on in comparison to CAD when used correctly. It's the users and the policies (or interpretations of those policies) that are the problem as well as the hospitals not exhausting, or even trying other modes of transport before relying on ambulance. It could work if there were a few changes - IFT specific resources should be utilized first, rural transfers should be vetted and hard conversations may have to be had. Those rural resources are there for a reason, and they should be left in their communities except in rare and unusual circumstances.

Hospitals should be held accountable for trying to use EMS to offload their patients, the only time metro resources should be used for transfers is for red transports or bed swaps. Then of course you have garbage IFT dispatchers who do revenge transfers, don't go to your flex then here's a transfer across the city. 

OPTIMA, LOGIS... are either of these programs worth the investment? It’s like watching someone use a $5,000 espresso machine to make instant coffee. The tool isn’t the problem. The people holding it are.

Retention/Hiring

Retention is a huge issue, largely due to low wages and toxicity. It is made very clear that no one is valuable and everyone is expendable. Just like the Street Paramedics most people now want to be casual rather than locked into a line, several FT/PT lines have been posted with barely any interest. A Benefits Eligible Casual line has received 20+ applications. It's really telling that people will apply for that rather than a regular line or will even forgo benefits and pension completely for the freedom to not be locked in. 

It seems stepping down from a BECE to a normal casual spot is often denied and staff are told it would be considered as leaving EHS and they would have to reapply as an external candidate. For experienced staff who are already demoralized enough to know they can no longer take the abuse a fulltime line absorbs, this is just another slap in the face. Some of us have done some checking with the union we found it's acceptable practice under the current collective agreement. 

Hiring processes are trash, they're hiring anyone with a pulse because they're getting so few applications. The admin assistant has been putting the postings up in Facebook community groups to get people to apply. To put it into perspective, one posting from C911 can receive around 2000 applicants whereas EHS dispatch gets about 200. People have no idea what they're getting into and many can't even type. It's treated as a retirement gig for some or a first job out of high school for others. It’s not a workforce, it’s a warm-body farm. Patient care and crew safety be damned. Easier to hire folks with no brains and indoctrinate them.

It's painful to work in EMS Dispatch if you care about the Paramedics. You can only maintain your integrity and try to instill good values on up-and-coming dispatchers for so long. Everyone I talked to is thinking of leaving, not because they want to but because they can’t watch the system eat itself anymore. They often bend the unworkable rules to protect Paramedics, tell the truth and get punished for it. No wonder they're ready to walk. 

In their place? Rule followers, yes-people, and fresh hires taught that loyalty to management matters more than competence. The message from Dispatch Managers is clear: Everything is fine, do as you're told and someday you'll be like us. If this is what’s happening in the nerve centre of Southern Alberta EMS, it’s no wonder there's little support for Paramedics when the wheels are coming off street side. So if you do have the misfortune to suffer an emergency and you're wondering, “Where’s my ambulance?”; call back and ask EMS Dispatch. Maybe you'll get someone who will still tell you the truth.